Receipt of Guideline-Concordant Pharmacotherapy Among Children With New Diagnoses of Bipolar Disorder

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 12/2011; 62(12):1443-9. DOI: 10.1176/
Source: PubMed


This study examined the extent to which children with bipolar I disorder received recommended treatment of mood-stabilizer or second-generation antipsychotic monotherapy and factors associated with its receipt.
Administrative claims data collected from January 1, 2005, to December 31, 2007, were used to construct a cohort of 412 privately insured children with bipolar I disorder. The primary outcome measure was the receipt of mood-stabilizer or second-generation antipsychotic monotherapy within 90 days of an index diagnosis of bipolar disorder.
Only 82 (20%) children received recommended first-line treatment for bipolar I disorder within 90 days of the index diagnosis, and 130 (32%) received no psychotropic medications. Of children receiving any medications, 200 (71%) received nonrecommended pharmacotherapy, most commonly antidepressant monotherapy (N=67, 24%) and combination pharmacotherapy (N=51, 18%). Youths who had been treated by a psychiatrist on the day of or 180 days before the fill date of medication were more likely to receive guideline-recommended care (risk ratio [RR]=1.64, 95% confidence interval [CI]=1.10-2.45) and to receive any psychotropic medications (RR=1.13, CI=1.02-1.24). Nevertheless, only 51 of the 209 (24%) children who visited a psychiatrist and 31 of the 203 (15%) who visited a nonpsychiatrist received recommended pharmacotherapy.
This study highlights significant gaps in the treatment of pediatric bipolar disorder. Most children in this sample received either no medications or nonrecommended pharmacotherapies. Additional research is needed to further assess factors related to the nonuse of recommended psychotropic medications and to the persistent use of nonrecommended pharmacotherapies for children with bipolar disorder.

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    • "It is difficult to escape the conclusion that overall quality of care was poor in the assessed sample, with rates of conformance hovering at or below 25 % for all but one quality measure, suggesting the need for thoughtful and directed quality improvement initiatives. We found that over three-quarters of youths received guideline congruent pharmacotherapy with a mood stabilizer or atypical antipsychotic within 12 weeks of bipolar diagnosis, an ostensibly encouraging finding in comparison to those of previous studies which found much lower conformance rates of 20–26 % (Dusetzina et al. 2011; Evans-Lacko et al. 2011). This may be related to differences in study populations in that prior studies focused on the privately insured who have different socioeconomic and demographic characteristics which may predispose them to greater skepticism about medications (Evans-Lacko et al. 2011). "
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    ABSTRACT: This study examined conformance to clinical practice guidelines for children and adolescents with bipolar disorders and identified patient and provider factors associated with guideline concordant care. Administrative records were examined for 4,047 Medicaid covered youth aged 5-18 years with new episodes of bipolar disorder during 2006-2010. Main outcome measures included 5 claims-based quality of care measures reflecting national treatment guidelines. Measures addressed appropriate pharmacotherapy, therapeutic drug monitoring, and psychosocial treatment. The results indicated that current treatment practices for youth diagnosed with bipolar disorder typically fall short of recommended practice guidelines. Although the majority of affected youth are treated with recommended first-line pharmacotherapy, only a minority receive therapeutic drug monitoring and/or psychotherapy of recommended duration, underscoring the need for quality improvement initiatives.
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